记忆谵妄评定量表中文版测评老年术后患者的效度和信度

Chinese version of the Memorial Delirium Assessment Scale( MDAS) :Clinical validity and reliability in old postoperative patients

目的：评价记忆谵妄评定量表（MDAS）中文版在老年术后患者中应用的效度和信度,为评估和筛查谵妄提供有效的工具.方法：对国际通用的MDAS进行编译,形成MDAS中文版.选择上海市第十人民医院骨科收治的82例股骨骨折患者,所有入组患者术后第1、2和4天均由精神科主治医生根据精神障碍诊断与统计手册第4版（DSM-Ⅳ）谵妄诊断标准进行临床诊断,同时由住院医生/研究生采用简易精神状态评定量表（MMSE）评估患者术前认知功能,并分别完成MDAS中文版和谵妄评定方法中文修订版（CAM-CR）的评定.结果：据DSM-Ⅳ谵妄诊断标准,82例股骨骨折患者术后谵妄总发生率为25.6％.术后第1、2和4天的发生率分别为24.4％、20.7％、14.6％,MDAS评分分别为（4.5±5.0）、（4.0±4.0）、（3.0±3.0）.因子分析提取出精神行为异常和认知功能障碍两个因子,分别解释总方差变异的63.9％和11.4％;MDAS总分与CAM-CR总分呈正相关（r=0.93,P＜0.001）.ROC曲线分析结果显示,曲线下面积为0.99 （95％CI：0.98～1.00,P＜0.001）,最佳诊断阈值取7.5分时,相应的灵敏度和特异度分别为95.7％、98.0％,阳性预测值和阴性预测值分别为91.8％、99.0％,诊断符合率为97.6％,一致性kappa值为0.92 （P ＜0.001）.MDAS中文版评定者间的一致性信度和24小时重测信度ICC值分别为0.96 （95％CI：0.92 ～ 0.98）和0.90 （95％CI：0.84～0.94）;总量表的内部一致性α系数为0.91,精神行为异常和认知功能障碍因子的α系数分别为0.93和0.81.结论：记忆谵妄评定量表中文版在老年术后患者中具有良好的效度和信度,不仅可以用于评估谵妄症状的严重程度,也可以作为谵妄的辅助性评估工具.

Objective：To assess the validity and reliability of the Chinese version of the Memorial Delirium Assessment Scale （MDAS） as well as its diagnostic potential among postoperative patients in general hospital.Methods：The translation-back translation method was used to obtain the Chinese version of MDAS.Eighty-two patients with thighbone fracture were enrolled from the Orthopedics Department of the Tenth People＇s Hospital in Shanghai.The clinical diagnosis of delirium of all the participants were made by an experienced senior psychiatrist according to the criteria of Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition （DSM-Ⅳ） on the first,second and fourth day after operation,separately.At the same time,the Mini-Mental State Examination （MMSE） was used to screen general preoperative cognitive function,the MDAS and the Chinese reversion of the Confusion Assessment Method （CAM-CR） were used to continuously assess postoperative delirium state.All those assessments were completed by trained resident/postgraduate of Psychiatry Department.Results：According to DSM-Ⅳ diagnostic criteria,the rate of delirium among old postoperative patients was 25.6％.While the rates on Day one,Day two and Day four were 24.4％,20.7％ and 14.6％ ; the MDAS scores were （4.5 ± 5.0）,（4.0 ± 4.0） and （3.0 ± 3.0）,respectively.Factor analysis of the MDAS suggested a two-factor structure：factor Ⅰ was named as neurobehavioral abnormalities,explained 63.9％ of the total variance; factor Ⅱ was named as cognitive disturbances,explained 11.4％ of the total variance.The MDAS total scores were positively correlated with CAM-CR （r =0.93,P ＜ 0.01）.Receiver operator characteristic curve （ROC） analysis obtained an optimal cut-off value of MDAS total score of 7.5,with the area under the ROC curve of 0.99 （95％ CI：0.98-1.00,P ＜ 0.001）.The sensitivity and specificity were 95.7％ and 98.0％ ; the positive predictive value and negative predictive value were 91.8％ and 99.0％.We also calculated the diagnostic accuracy and the kappa value of 97.6％ and 0.92,（P ＜0.001）.ICC for Inter-rater agreement and 24-hour test-retest reliability of MDAS were 0.96 （95％ CI：0.92-0.98） and 0.90 （95％ CI：0.84-0.94）,respectively.The MDAS had good internal consistency with Cronbach α of 0.91.In addition,the Cronbach α coefficiency were 0.93 and 0.81for neurobehavioral abnormalities and cognitive disturbances.Conclusion：The Chinese version of the MDAS may be a reliable measuring instrument for assessing delirium among old patients.It not only could be used to monitor severity of delirium symptoms,but also assists clinicians for delirium screening and diagnosis in general hospital.